HIV and Drug ABUSE

Dec 24, 2001

I have an HIV Pos. gay friend who also has a drug prob. He is very intell. good job, and so on. Up to this point has been relatively in good health. I am concerned about the efects of the drugs on his body being HIV Pos. and the effect on his medications.

Response from Dr. Pavia

This is an important question. Most of us who care for people with HIV are seeing an ever increasing amount of drug use. This includes alcohol, prescription drugs, and "club drugs" as well as the usual favorites, methamphetamine, cocaine and heroin. Why?

One reason may be that drug use, even relatively controlled drug use, leads to risky behavior and results in people who should know better getting infected. Another may be the stress and anxiety of being positive, even in an era of effective treatment.

I am a realist, and certainly not a rabid anti drug crusader. However, we see a lot of problems that recreational drugs cause among positive people. Drug use often messes up your ability to take your meds reliably, leading to treatment failure and resistance. It can lead to ongoing risky sex, leading to herpes, gonorrhea, warts and possibly even anal cancer for positive people, and of course spreads the virus to the people they have sex with. There is even a risk of acquiring HIV that is treatment resistant.

Drug use often leads to the destruction of relationships and the loss of jobs. There can be interactions between recrational drugs and HIV medications that can be life threatening. One example is the interaction of ecstasy and Norvir, which can be lethal.

The most controversial issue is whether drug use damages the immune system. It is not absolutely clear that drugs, by themselves, lead to loss of T cells, but that is not the end of the story. Poor nutrition, lack of sleep, lack of excercise are all problems that go with drug use and can lead to immune system injury. Heavy use of uppers (ie coke and meth) seems to be particularly bad.

So, your friend is probably putting a lot at risk. However, it is not just a matter of "just say no". He may need to speak with a counselor or psychiatrist to better understand what is going on and think about an approach to it. Being intelligent and successful is no protection against substance abuse.

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